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On The AMA's Opposition To The Public Option

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reprinted from dailykos.com by DemFromCT

Back in the days of the buggy-whip and leeches I graduated from medical school, ready to start my internship and residency in pediatrics. One of the leading journals of the day was the Journal of the American Medical Association (JAMA), and membership to the AMA got you a subscription to that and the specialty journal of your choice, so membership seemed like a no-brainer.


my dusty unused MD bag

Also a no-brainer was for every member of the graduating class buying one of those black doctor bags, stuffed with tuning fork (to test hearing) and stethoscope for house calls (I've made them, but only with a stethoscope and otoscope to check for ear infections.) The little black bag gathers dust in a closet somewhere, a relic of a by-gone era. I think I may have once lent it to a neighbor for a Dr. Watson prop in a Sherlock Holmes play. There's nothing in it that would do a patient any good. The useful stuff (including the tuning fork and the stethoscope) have long since migrated to my office.

It turns out that the AMA is just as much a relic of a by-gone era as the little black bag. It's been decades since I renewed my membership, and the professional societies I belong to have been more relevant to my career, and as it turns out, more open to health reform. The AMA always seemed more interested in the "town" side of the town-and-gown argument, and never really seemed like an advocate for patients, just an advocate for the highest possible reimbursement for docs. Their whole point of view seemed more suited to defending the POV of the vanishing solo doc working out of his home office, and ill suited to taking on and dealing with institutions. Their standardization of practice improvements and billing codes could be adopted and used without being a member.

I hadn't given the AMA much thought at all until this past Wednesday:    

As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system.

The opposition, which comes as Mr. Obama prepares to address the powerful doctors' group on Monday in Chicago, could be a major hurdle for advocates of a public insurance plan. The A.M.A., with about 250,000 members, is America's largest physician organization.

While committed to the goal of affordable health insurance for all, the association had said in a general statement of principles that health services should be "provided through private markets, as they are currently." It is now reacting, for the first time, to specific legislative proposals being drafted by Congress.

Yeah, there was push-back, as mcjoan chronicled. Our own doctoraaron had enough, and joined Chris McCoy and the majority of doctors who are not members of the AMA (doctoraaron belongs to the American Academy of Family Physicians, just as I do to the American Academy of Pediatrics.)

And as many of you noted, opposition to health insurance by the AMA is as old as the last century. From Wikipedia:

For most of the twentieth century, the AMA opposed publicly-funded health care because of concerns physicians have had over the financial implications of such plans and the worries that a prominent government role in coordinating medical financing would inappropriately interfere with the doctor-patient relationship. When Progressive Era advocates proposed compulsory health insurance in the second decade of the twentieth century, the AMA initially took a cooperative and moderately open position to the idea, but by 1918 the Association had moved to a strongly oppositional position regarding compulsory health insurance. Ronald Numbers' 1978 book, Almost Persuaded: American Physicians and Compulsory Health Insurance, 1912-1920, provides an account of the AMA's policy positions during this early period.

A lot of commenters angrily tore into the AMA, and some did the same for doctors, as if we all were represented by the AMA. But that's simply not so. Wikipedia actually has a nice balanced piece on the membership issue:

Physician membership in the group has decreased to lower than 19% of practicing physicians. In 2004, AMA reported membership totals of 244,569, which included retired and practicing physicians along with medical students, residents, and fellows. The medical school section (MSS) reported totals of 48,868 members, while the resident and fellow section (RFS) reported 24,069 members. Combined they account for almost 30% of AMA members. [3] If every other member of the AMA was a fully qualified practicing physician then the AMA would represent 19% of America's practicing physicians (There are currently approximately 900,000 practicing physicians in America). However, MedPage Today estimates that the AMA only represents 135,300 "real, practicing physicians" as of 2005 (15.0% of the United States practicing physicians). [4] When asked about this, Jeremy Lazarus, MD, a speaker in the AMA House of Delegates, stated that membership was stable, avoiding commenting on the low overall numbers (2005 AMSA annual meeting, AMA vs. PNHP healthcare debate, Arlington, Virginia).

But arguing how strong or formidable the AMA is - or is not - misses the point. The bottom line is that health reform at some level is going to mean less money for doctors. And as Yglesias notes:

Which doctors don't want. And unfortunately for the country, unlike insurance companies doctors aren't unpopular, so if I run around saying "Jay Rockefeller has a great idea and only doctors hate it" people are going to give me funny looks rather than cheer.

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